Henry Jude Karwowski-the Unborn BIRTH

2007-06-15 =  date of web site construction

 of Nascence of memoirs and literary arts -

 comes into being: ....................Open letter to Birthing Families 

 Dear Birthing families of Indianapolis, outlying areas of Indiana, and all the good people of America.  I write you all with a tormented heart, aching for the unnecessary discomfort, anxiety and isolation some of you have endured.  This is in response to information informally gathered in Indianapolis, the Indianapolis area, and Dupage county hospital of Illinois over the last 18 months.  To wit it is that:

• IT IS NOT OKAY for a healthy laboring mom with an uncomplicated pregnancy to be made to be in bed for continuous fetal monitoring for the convenience of the hospital staff.

        ·       Laboring moms do get epidurals PRIOR TO 4 centimeters dilation

        ·       Women get epidurals BEFORE labor starts

        ·       Health care givers exist that practice PATIENT DIRECTED CARE

        ·       Health care givers exist that practice family  centered care

I worked for 25 years in Portland, Oregon, as a "labor and delivery/OB/Birth/Perinatal Nurse, starting in 1978.  It was a maternity unit where we fought and toiled to bring the American Birthing culture out of the middle ages; where we threw out the leather restraints that bound women's wrists and ankles in cold sterile delivery rooms with no loving husband/support person allowed; where we overcame archaic and draconian philosophies reminiscent of the dark ages that put the King, Bishop, and Doctor at the top of an inhumane and manipulative linear hierarchy with everyone else including the patient at the bottom. We educated caregivers(nurses obstetricians, pediatricians. anesthesiologists, residents and students) in the health care system about non-judgmental attitudes, compassion and empathy, and above all about the practice of patient-directed care in a setting of family-centered care.  Visionary managers screened out the nurse mechanics and technicians for the truly caring.

Imagine the shock I received when I retired here in Indianapolis and began to hear stories from recently birthed moms about a subset of violations of compassionate health care, and of some vestiges of these cruel and archaic practices of times long past still existing!  (Subset is that of patients choosing epidurals) I will share some of my experiences.

 I was told of an anesthesiologist practicing at St Francis Mooresville campus who requires a dilation of 4cm before he/she will place an epidural, with Nurses at same campus defending the practice.  I listened to stories of anguish at the practice of making loving husbands leave their laboring wives during epidural placement at St Francis hospital on Emerson, south side campus.  A nurse at IUPUI hospital also verified most husbands are asked to leave by the anesthesiologist during said procedure.  Another RN identified as working labor and delivery at Clarian North (7-8-2007) confirmed that husbands were asked to leave for epidural placement there, not only at the behest of the anesthesiologists but the desires of the nurses.  I didn't know what was more intense, my breaking heart learning that these outrageous and dehumanizing practices persisted in violating birthing families; or, the anger that somehow these defilements were still allowed to be perpetrated.  Questions just popped up in my mind?  What is being taught in nursing schools about collaborative practice and patient advocacy IE: The nurse (who identified herself as the OB unit manager) I had spoken with at St Francis Mooresville campus, when I confronted her about these atrocities and asked her point blank "What about the nurses' role as patient advocates?"  She appalled me with the answer: "sometimes".  Sometimes????  I felt (figuratively) like I was going to have a seizure!  I told that manager, among other things, that she and the Mooresville campus philosophy were shameful and disgusting.   It made me think: "Must we ask the RN taking care of us in hospitals if their "RN" means: Registered Nurse (patient advocate) or Registered Nurse (handmaiden/servant to despots) or perhaps more rudimentarily, Registered Nurse (mechanic)?  Why are anesthesiologist allowed to practice in a manner that violates the birthing family support continuum?  What are the CEOs doing to create and maintain the corporate infrastructure that nurtures its staff to work in the 21^st century?  Where are the obstetricians' efforts in supporting epidural administration when the patient wants it?  Why are birthing families allowing themselves to be treated this way?

During my last few years in Portland, Oregon, I was blest with the opportunity to work with a pregnant mom who didn't want any labor pain.  When her competent, supportive, and compassionate Obstetrician determined that both the mother and baby were healthy, they as a team planned an induction date.  When the primipara came in, the epidural was placed and activated. When the patient said she was sufficiently numb, I started, and managed the pitocin; and, the patient delivered a healthy baby within the statistically average number of hours with no complications.  This was only possible I believe because anesthesiologists in Oregon grew professionally enough to move past the aberrant thinking that a patient had to be 4 cm before epidural placement.  I saw the anesthesiology department debunk the passe' routine not only with new and lower concentrations of local anesthetic with fentanyl in the epidural drips augmented by the computer development of programmable dosage; but primarily to care compassionately enough to respond to the patients' need for pain control.  And this wasn't the only time such a thing occurred!! That very same patient came from Europe to have her second baby the same way with the same OB, anesthesiologist, and Birth nurse (I considered it a great honor to be he).  Please be advised that while this is not standard practice at the Portland hospital where I had retired from, it clearly is a reality.  

I believe that is our duty as health care professionals to not only provide and maintain the most clinically excellent and safest possible technical environment for a laboring family; but, to do so with all the compassion and love for humanity as our hearts and souls can muster.  It is a clear mandate, a moral imperative,  Absolutely nothing less is acceptable.

  Does a birthing family need to go to Oregon for a hospital where the loving husband can stay with his laboring wife during an epidural? No, A nurse at the Community south hospital told me in a phone interview that husbands are never asked to leave during an epidural, the Obstetrician decides with his/her patients when an epidural is to be administered; and it is often a part of a plan ahead of time with patient, obstetrician, and nurse. A loving Father of three said that his holding of his wife’s anxious clutching hands were critically important as he maintained loving supportive presence during the epidural placement at Community North Hospital.  One random informal call to a St.Vincent Carmel RN in Maternity, revealed that neither are any husbands ever asked to leave during the epidural placement; nor, is there any arbitrary cervical dilation for epidural administration. Curiously, I learned that variations in a system may prevail.  Today, July 6th, 2007, I talked with a nurse at another St Vincent hospital ( St V women's hospital on township line road) and was informed that it depends upon the anesthesiologist; but, 80 to 90% of Fathers are NOT present during the epidural placement.  The most tragic part of this conversation was that it is not a mandate, and the husbands were reported to have chosen to leave.  I ask all of you Fathers of that baby, you husbands - WHY???  Where were the roaring cacophonous alarms that should have gone off in your soul? Were the classes not clear that your wife had to curl up, get a needle in her back, have a stinging local before placement? Did you not get together with other "Fathers to be" or "Parents to be" for support and mutual education?? What could have made you leave her?????  Were you bullied into leaving by some veiled threat from the anesthesiologist like "I will be nervous if you are here and may not do the best job worrying about you fainting".  God, I hope not; for, if an anesthesiologist cannot be clinically excellent in a family setting, he/she should not be there....... Where is the outcry of opprobrium? To their credit at St V on township line rd, I joyfully received the report that many epidurals are given early, as in induction so that the birthing mom isn't uncomfortable during labor!! Bravo for that!!!  Too bad about the anesthesiologists though and/or the fathers that are abrogating their parental rights.  Fathers I ask you, are you unaware of your rights?  Thirty some years ago, the establishment gave the same excuse (as above) for not even allowing fathers into the building where their wives were to labor and birth.  What is it? PLEASE tell us all! 

There is a dragon here to slay!

  One mother told me that how a patient was treated in terms of being able to control their birth depended on the randomness of who was on duty when they were admitted to the hospital; and, this experience was told and retold to her by numerous other mothers.  I hold that it is shameful to subject a birthing family to such odious "hit or miss" care.  I believe all birthing families deserve to have patient directed care and a loving, uninterrupted continuum of family support with no separation of Mom, Dad, and baby during the birthing process with zero tolerance for inhumane, antediluvian, and oppressive practices starting now.

Why go to a hospital that practices otherwise?

As I ponder the status of birthing care, I realize, that in the final critical analysis, none of the history really matters if COMPASSION is the single crux of care, its foundation from which all else is based.

I think that if compassion is the basis for care, then there would be no question when a laboring mother would get her epidural; if compassion were paramount even the mere thought of having her loving husband torn away during the epidural administration would be inconceivable.

Just today 6-20-07 A glowing pregnant mom told me about her husband's support at different hospitals and how he stayed through the epidural placementfor the first 2 babies.  But when she had her last baby at St.Francis hospital south campus, the husband was asked to leave; and, to add "salt to the wounds" when the baby was suddenly close to being born as the epidural set up, the anesthesiologist called for everyone to come be at the birth except her husband.  While in the intense moment of getting ready to birth, with all the medicinal effects of the epidural; She, herself, had to speak up to get her husband back in the room with her.  To compound the atrocities of thoughtlessness, the pregnant mom said that the anesthesiologist's excuse for making the husband leave was -  its a group decision, all the anesthesiologists adhere to the policy..........it's just the way it is.  That lack of accountability I can find nothing less than an abrogation of personal and professional backbone.  It reminds me of the immaturity of a squabbling child pointing always at  another and saying "it's their fault" -it's always someone's else's fault!  I think it also smacks of the theme we read about in childhood fairy tales that sometimes serve a vital purpose in educating little children to danger.  We hear often in these fairy tales about the "evil prince, or princess" who uses their knowledge and skills to control others instead of sharing that knowledge and/or empowering others to control their own lives Or would it be the evil troll that exacts a bridge tax or else some terrible thing will befall the unwary traveler? The best term for that type of behavior eludes me as I can thing of nothing that is egregious enough, can you?

Another thing to consider, this pregnant mom actually said about her husband torn away from her side (the husband, the co-creator, he who has given to that miracle of conception and love, one who deserves and needs to be with his beloved wife)  was that “oh that was the only thing that I would say was bad about my experience”.    No one should have to make a sacrifice like that while birthing.  Righteous indignation must be voiced.  I ask all you loving husbands and father's of that cherished baby to be born to take a stand.  Ask yourselves: "How dare anyone make me leave my beloved wife and unborn baby at a point when my spouse is so vulnerable?.......and worst of all: to use knowledge and skill to leverage that manipulating power!"

I believe while we are taking a stand to change these practices, the same love of humanity should be extended to the nurses and doctors in this arena.  What would change the practice to maximize caring? Perhaps something about epidurals in birthing classes, a film about epidural placement, a compassion-based pamphlet co-authored and designed by anesthesiologists and birthing families to transition to greater family control of their birth, anesthesiologists and nurses coming to birthing classes, hearing personal sorrows of the families?  What do you think?

Please submit ideas to give birthing families back their birthing experience.  Another idea that came into my head is a boycott of the entire St. Francis and IUPUI med school hospitals, the Clarian system; and, any other perpetrating health systems, or singular hospitals like St V township line rd. -  any other ideas??